Challenges

Unaffordability of Post-Rape CareDuring an Experts’ Forum, Liverpool VCT raised a concern over the affordability of post-rape care, especially among women living in slums, rural areas, and in drought stricken areas of Kenya. It was observed that the average cost of post-rape care services is USD 27 per outpatient client.61

We have talked about the empowering things sport can do, but we do face challenges as demonstrated by the experiences of our programme partners. In this section we will focus on the difficulties of addressing SRHR and how sport can help.

Challenges that affect a girl’s physical access to sport and all the positive benefits that sport can offer.

Challenges that arise in the designing of effective sport programmes for adolescent girls.

Challenges that can negatively affect the climate of a sport programme, meaning the relationship with the community, stakeholders and the girls themselves.

The following challenges may impact the successful delivery of sport programmes addressing SRHR.

• LiteracyLiteracy is important in accessing vital health information and in health seeking behaviours. Governments have done little to ensure that illiterate women can submit grievances about the SRH services that support them. Many illiterate women interviewed by Human Rights Watch57 in India, for example, said they could not use grievance options without support to file their complaints. Illiterate women who were interviewed in Kenya said grievance mechanisms, such as suggestion boxes on health facility walls, were meaningless to them.

Tip: “Talking Stick” If you are facilitating your first session (life skills) you might be unsure of the literacy levels of the group. Be sure to offer all information in this first session in several forms, including written and spoken words, and pictures, always using clear language. Tailor activities so that adolescent girls have the option of expressing themselves with words, pictures or role plays.

If participants are hesitant to talk, you can use a “talking stick” to get things started. Explain that you, the facilitator, will pass the talking stick (a cane, stick, or rolled up piece of paper) to one participant. The participant with the talking stick shares, while everyone else listens. Then the participant passes the stick to another participant and that person talks while everyone else listens… and so on.58Using a ball, especially if conducting or leading sessions out on a sport field or court, works just as well. Participants can throw the ball around and whoever has the ball can talk while the others listen. It may be more fun than passing around a stick and it has the benefit of getting the participants in the mind-set of playing sports!

• Social StigmaAdolescent girls’ access to SRHR information and services is often opposed. When launching Family Life HIV Education59 (an SRHR curriculum being implemented in schools in some Nigerian states), a Nigerian organisation remarked that the programme was initially opposed by parents and it had to be reframed by removing some components to gain support. The organisation observed that: ‘There was uproar against it when we first conceived it as the “National Sexuality Education Curriculum,” and in response we removed certain sexuality issues such as masturbation and changed the name to “Family Life HIV Education,” with States being guided to implement it as per their cultural peculiarities and contexts.’ Similarly, a staff member from the Botswana National Youth Council noted that earlier programmes initiated by its members about adolescent SRHR were opposed by parents. To gain parents’ support, organisations had to contextualise the programme in relation to HIV/AIDS and rape.

• Peer PressureWith the breakdown of family ties and in many cases the absence of any family, the pressure from peers on adolescent girls can be very high. This often has a strong impact on girls’ decision making, early sexual initiation and unprotected sex. Sport programmes create groups of peers who share similar positive healthy seeking behaviour and can support each other when confronted with peer pressure from outside of the group, in school or on the street.

Tip: Role PlaysRole-playing in sport is a great way to examine and learn about real life situations especially in relation to SRHR. Role-plays can be more interesting and fun than talking about situations, and everyone – role-players and audience – can learn a lot through the performance. They help participants develop an awareness of how others see situations and give them a chance to try out new ways of dealing with situations. Goal Programme uses role plays to create situations where peers might be negatively influential and then asks girls to role play, practicing different responses to the situation.

• Opposition to Comprehensive Sexuality EducationOver the past decade, there has been considerable attention and visible opposition to comprehensive sexuality education. This has led to funding for abstinence-only and abstinence-until-marriage programmes and the denial of medically accurate information for adolescent girls. Even though there is increasing information and evidence to support a comprehensive approach, some political leaders continue to ensure that abstinence-only programmes continue to be funded. On-going education and advocacy for comprehensive sexuality education are urgently needed to overcome this challenge.60

Useful Example – Overcoming Opposition In Nigeria, the Youth Empowerment Foundation (YEF) uses the Goal Programme to build the life skills, literacy and financial skills in addition to football skills of younger adolescent girls, ages 11 and 16 years old. Because YEF implements Goal in schools, adaptations were made to the curriculum to ensure that it adhered to school policies that advocated abstinence. Despite the exclusion of discussions on contraception, YEF emphasised that if a girl asked a question about contraception, it would be answered truthfully. It was their way of adhering to the ban but at the same time, ensuring that all participants had access to information.

• Unaffordable and/or Poor Access to Health Services and FacilitiesSport programmes attempting to connect their participants to sexual and reproductive health services might find either that the services are unaffordable or are hard to access because of distance. Assisting adolescent girls in obtaining the help they need could be frustrating for both the programme and the participants. Such a scenario could even discourage girls and young women from asking for help or demotivate them from wanting to learn more about their SRHR. In these cases, practitioners should give careful thought to approaching and forming strong relationships with government or private services, negotiating lowered fees or inviting health workers to visit the programme at certain times to provide simple services on site.

Useful Example – Connecting to Health Services Due to a partnership with the Melchizedek Hospital, Boxgirls Kenya made it possible for 100 girls from their boxing programme to receive a medical check-up. The majority of the girls were diagnosed with skin infection diseases and malnutrition. The hospital gave Boxgirls Kenya a discount for every girl’s treatment, counselling and drugs. Parents and caregivers are appreciative of the support the organisation has shown towards the well-being of the girls in the programme. For many of the girls it was the first time they had ever received medicine. This is due to the fact that when they are sick, most of their parents do not take them to hospital but instead use traditional practices, like local herbs.

• Cultural/Religious BeliefsThere are also misunderstandings when it comes to sport and its impact on adolescent girls’ SRHR. Some fear that playing sport will cause loss of virginity. A common myth in some cultures is that the physical exertion of sport, such as running, kicking or jumping, will cause the hymen to tear. An intact hymen is erroneously seen as a physical indicator of virginity. In societies where a girl’s virginity before marriage is sacred, the threat of sport causing a tear can be a very serious concern. One of our programme partners in Kenya reported some of the girls and community members feared that the girls who played football would never get pregnant.

Adolescent girls often have misunderstandings about the safety of participating in sport while menstruating. In addition, sanitary pads and tampons are expensive and are not a financial priority for many families, especially in traditional cultures or among economically disadvantaged families.62When girls begin to menstruate, they are often confined to their homes and temporarily or totally cease participation in sport.

Tip: Fear of Virginity Loss

Inform caregivers about your intention to discuss reproduction with their daughters as part of the sport programme. Once you have the support to have an honest conversation, you can educate girls that the only way to lose your virginity is through sexual intercourse. A girl’s hymen tearing is a physiological occurrence that can happen in a variety of ways, only one of them being sexual intercourse. Any pelvic trauma, such as that experienced when climbing a tree, riding a bike or participating in sport, can also cause tearing.63

Encouraging girls to own their bodies and make decisions based on their own well-being as opposed to cultural stigmas and myths is the next step in this conversation. Include caregivers and community members in the conversation, as their fears around their daughters losing their virginities can limit participation.